Modeling the Mediating Effects of HIV-Related Stigma on the Associations Between Race/Ethnicity and Antiretroviral Therapy Adherence and Viral Suppression Among Diverse Racial and Ethnic Minority Women with HIV.

Racial and ethnic minority women with HIV experience higher levels of HIV-related stigma, have poorer adherence to antiretroviral therapy (ART), and lower viral suppression rates than men and white women with HIV. Using structural equation modeling, we examined the direct and indirect associations between race and ethnicity, ART adherence and viral suppression through HIV-related stigma dimensions (anticipated, internalized, and enacted) among 542 racial and ethnic minority women with HIV (37% Black [excluding Hispanic and Haitian]; 34% Hispanic [of any race]; 29% Haitian [of any race]) who completed a survey about women-centered HIV care. All paths from each racial and ethnic group to the mediators and outcomes were estimated in comparison to the overall sample estimates. Approximately 62% of participants were adherent to ART, and 91% were virally suppressed. Haitian ethnicity was associated with increased anticipated stigma (β = 0.33, 95% CI: 0.19, 0.47), decreased internalized stigma (β = - 0.16, 95% CI: - 0.31,- 0.02), and decreased viral suppression (β = - 0.48, 95% CI: - 0.91, - 0.15). Hispanic ethnicity was associated with increased viral suppression (β = 0.43, 95% CI: 0.13, 0.85) and decreased anticipated stigma (β = - 0.25, 95% CI: - 0.37, - 0.13). Black race was not associated with any of the variables examined. None of the HIV-related stigma dimensions had a significant mediating effect. Our findings highlight the need for in-depth qualitative research to understand the unique cultural beliefs/practices and perceptions about HIV within the Haitian population that drive HIV-related stigma and decreased viral suppression.